Medicare records from over 53 million patients were sampled to provide, sequentially, three criteria based 5% samples to provide over 200,000 records for analysis. The data were analysed for patient outcomes and cost and the results were very favourable towards nursing care. The authors stated that patients cared for by nurses: '...had significantly improved outcomes compared with all primary care physician provider groups regarding healthcare utilization, patient health outcomes and healthcare costs.' They conclude: 'Our results, suggest nurse practitioner engagement in chronic patient management is associated with lower cost and quality care' and: 'This research might also provide direction and influence conversations taking place in other developed countries such as the UK, Canada and the Netherlands.'